Symptoms of high versus low

I remember when I was first diagnosed as diabetic, about nine and a half years ago, someone (a nurse at the hospital when I was there, I think) telling me that high and low symptoms can be very similar — enough so that you may not know the difference.

Obviously she wasn't diabetic, because while there are some similarities, I've never thought it difficult at all to tell which I am.

Crashing, to me, is perfectly obvious.  I get tunnel vision.  I get shaky.  I can't concentrate.  In short, I feel like shit.

Going high can feel like shit too, but in a different way.  I often get heartburn, a stomach ache, and/or a headache.  Sometimes I feel dizzy (hence the minor similarity to crashing) but it's in a different way than when I'm low.  And if I'm high for a long time, of course, I get dehydrated.  My hands and even my eyes start feeling dry, which is a perfectly miserable experience.

One other symptom of going high that I've noticed is irritability.  It's not like the second my blood sugar goes up, I get grouchy.  It's more like if I'm high over an extended period of time — for instance, if I'm struggling with highs for several days in a row — I start feeling illogically angry about everything.  I've gotten irritable when I've crashed before, but it's rare.  Usually I know I'm crashing right away, whereas I don't always realize I'm high unless I check my blood sugar, so I think that makes a difference.  If I know I'm cranky because I'm crashing, for instance, it's much easier to stop being cranky once I realize the cause.  When I'm high that's a much more difficult attitude adjustment to make.

In fact, that was one of my unknown symptoms in the months leading up to my diagnosis: I was much more easily provoked to anger.  I worked at a preschool at the time, and I had noticed that I was getting angry at the kids more easily when they didn't listen or misbehaved.  I didn't know why it was happening at the time, but I definitely noticed that I was having to work harder to control my temper.

What about you?  What symptoms do you have when you're crashing, and what are your symptoms when your blood sugar is high?

Medical studies: What's in it for me?

I was telling a friend of mine recently that I was going to be participating in another medical study, and I was rather surprised when her response was, "How does this benefit you?"  I've been participating in studies for several years, and I can tell you, that's the first time I've ever received that particular response.

I won't lie.  There are plenty of ways in which it does benefit me to participate in these studies, and that's part of why I do.  I get paid — more for some studies than others — but because I don't get that money until the study is over (sometimes 4 or 6 months), that's not a major deciding factor.  Many of the studies provide my insulin, needles, and test strips for duration of the study, which is a huge incentive for me, especially since my co-pays have gone up.  Sometimes they provide gas cards (usually $20) for every visit you have to make to the doctor's office, which is nice considering the price of gas lately.  Some study participants have to drive a long distance to get to the clinic, but I don't (and my car gets decent gas mileage), so those gas cards generally help to keep me in gas throughout the duration of the study.

I'd be lying if I said these weren't influential reasons why I do the studies, but they aren't the only reasons.  I like being part of the process of new medications and devices coming out.  I've gotten to experience continuous glucose monitors and new insulins this way.  Usually these studies are a ways into the testing, too, so I don't have many concerns for my health and safety, and I can always back out of the study if that changes.  And of course, there is always the satisfaction of knowing that I'm helping these new medications and devices become available to everyone.  It's hardly my biggest reason for doing the studies, but it's still a good feeling.

So I'd say there's quite bit in it for me — but really, do I have to prove that in order for this to be considered a good thing?

Diabetes isn't a death sentence

There was an article on USA Today the other day that I really appreciated.  Not only did it specify that it was talking about type 1 diabetes, it also was attempting to dispel one of the fear-inducing myths surrounding diabetes: that as a type 1 diabetic, you are going to die young.

Life expectancy improves for type 1 diabetics

See?  Isn't that beautiful?  "Type 1" clearly specified, even in the title!

The article looks at life expectancies for type 1 diabetics in 2 groups: diagnosed between 1950 and 1964, and diagnosed between 1965 and 1980.  Life expectancy for the first group was 53.4 years, versus 68.8 years for the second group.  Compare that to an average of 72.4 years for the general population.

Of course, the article doesn't address people diagnosed after 1980, probably because none of us are old enough to start dying yet.  (Ha, ha.)  But I can only imagine that our life expectancy has gone up even more, and might even be about equal to the life expectancy of everyone else.  In fact, because having type 1 diabetes makes you so health-conscious, I wouldn't be surprised if our life expectancy is even longer than the general population — we certainly pay more attention to diet and exercise than the average person does!

This just goes to show how much of a difference modern medicine can make.  With modern insulins and glucose meters, pumps, and continuous glucose monitors, we are given such precise control over our blood sugars that we can actually mimic the insulin production of a normal body fairly closely.  And if you keep your blood sugars within normal range most of the time, then theoretically you shouldn't have any of the complication of diabetes that come from having high blood sugar for extended periods of time.  It may take a lot of work, but it's essentially like not having diabetes at all!

Progress on preventative vaccines for type 1 diabetes

One of the top headlines on USA Today the other day reported mixed results on type 1 diabetes vaccine trials.  One of the trials seems very promising — I don't understand all of this, and by the way the article is written I'm not sure the journalist did either, but it sounds like the vaccine essentially turns the patient's T cells into cells that protect beta (insulin-producing cells) instead of attacking them.  The drug is in phase 2 trials, and so far so good — although it doesn't prevent diabetes, it looks like it can at least delay the failure of insulin-producing cells.

The article also reports on another trial, one that didn't work.  The second trial was also looking for an antigen that would preserve insulin production in diabetics who were just diagnosed.  The article says that the antigen works in mice, but not in humans.

What I find curious is that they are only testing these drugs on people who have already been diagnosed.  Why?  Modern medicine does enable us to identify people who will become diabetic, but aren't yet.  For instance, the children of type 1 diabetics are often tested for signs of an autoimmune response, such as elevated T cells.  I think it would be much more interesting to test these drugs on people who are destined to be diabetic, and see how long the vaccines would hold off their diagnosis.

Say which type of diabetes you mean!

If you have read my earlier posts, you know that one of my pet peeves is people — especially journalists and scientists — not specifying which type of diabetes they mean.

Take, for instance, this article on the rapid increase in diabetes cases.  Anyone who knows about diabetes can figure out that the article is talking about type 2, but they don't say it anywhere it in the article — not once.

Now, I don't have anything against type 2 diabetes, and I agree that the rapid increase is alarming.  However, I think it's important to note which type of diabetes you are talking about.  A rapid increase in type 1 cases would mean something very, very different than a rapid increase in type 2 cases.

Splitting your Lantus dose

I recently decided to start splitting my Lantus dose.  I tried this a few years ago, before I started doing so many studies, and didn't find it helpful.  Recently, however, I became convinced that I really needed to.  If I took Lantus in the evening, with dinner or shortly before bed, my sugars were consistently very high around dinner and bedtime, and I was at risk of crashing in the wee hours of the morning.  If I took Lantus with breakfast, my sugars were always very high when I woke up — and I'm talking in the upper 200s.  High.

The reason for this is that Lantus isn't perfectly even across the entire 24-hour period.  It has a peak around 2-3 hours after you take it, and tapers off over the last few hours of the 24.

So I started splitting my dose.  I take half with breakfast, and half with dinner.  It works out great because it's not as important that I take it at the same exact time every night, and I'm not having as many problems with highs OR lows.  If you have problems with dramatic swings in blood sugar that you think may be caused by Lantus's peaks and valleys, I highly recommend talking to your doctor about splitting your dose.

Medical studies: Should you participate?

I don't often blog about it, but I participate in medical studies fairly frequently.  I've done one study on continuous glucose monitors, two on new kinds of insulin, and one on a new kind of glucose monitor.

No matter what the study is, I generally enjoy participating very much.  I wish I could say that I do it to help out the study of diabetes and to benefit other diabetics, but I'm afraid I'm not that noble.  Some of the biggest reasons I do it are because I get to try out cool new medicines and gadgets for free, because the studies generally pay for all of my supplies, and because on top of all that, I get paid for it too.  It's not a ton of money, but it's a nice little bonus, especially at the end of a long study.

How much they pay varies from study to study.  I recently did one that paid $100 for just one day.  That made getting up at 5:30am in order to get to my doctor's office by 6am totally worth it!  Other studies may just pay $30 or $40 per office visit, but when you're in a study that lasts for months, that can really add up (and they pay it all at the end).  I was in another study where I got a gas card every time I came in, which was highly appreciated considering gas prices lately, and the fact that I live across town from my doctor's office.

It also varies whether the medicine you get to try out really has any benefit to you.  I didn't get to try out the new glucose meter, for instance, just had to give some blood for testing purposes.  For one of the insulin studies I was in, I was actually randomly put into the control group, so I didn't get to try out the new insulin at all.  (I didn't mind much, though, since they still paid for all my supplies during the study.)  Another study I did, however, introduced me to a fantastic new type of insulin that I will be switching to the instance the FDA approves it.

Finally, not everyone feels this way, but I find the studies to be very interesting.  I like getting to see firsthand the process that companies have to go through in order to gather enough data to submit their medicine or device to the FDA.  I like meeting other people in the studies, both the other participants and the research assistants.  I haven't had the pleasure of knowing other diabetics, so it's always nice to talk to others with the same condition.


My point is, though, that there are a lot of good reasons for participating in medical studies, and not all of them are altruistic.  In my opinion it's well worth asking your doctor's office if they have any opportunities for you to participate in studies, and if not, where else you can check.  It seems like university hospitals have the most opportunities, but some studies will even be advertised on Craigslist!